Key result
Percutaneous external fixation for intertrochanteric fractures in high-risk elderly patients resulted in 80% returning to pre-fracture ambulatory status at 1-year follow-up.
Why the study?
In patients with anesthesia or surgical hazards, external fixation should be explored as a safe approach to reduce operative time and complication risk in intertrochanteric fractures.
Does percutaneous external fixation improve outcomes in elderly high-risk patients with intertrochanteric fractures?
Observational (n=28)
No
Does percutaneous external fixation improve outcomes in elderly high-risk patients with intertrochanteric fractures?
External fixation is a safe and effective alternative for treating intertrochanteric fractures in elderly patients with high surgical risk.
May offer alternative for high-risk elderly unsuitable for internal fixation; leaves open need for RCTs before practice change.
Background: Internal fixation is gold standard in treatment of intertrochanteric fractures, but in patients with anesthesia or surgical hazards the external fixation should be explored as a safe approach to reduce operative time and complications risk. Objective: To assess the outcome of external fixation of an intertrochanteric fracture is in elderly patients with co-morbidities. Methods: Twenty-eight elderly patients with non-pathological fractures, closed, who were 65 years old or older, unsuited for surgery for a long period, and had chronic uncontrolled medical problems such as hypertension, diabetes mellitus, or heart disease were included in the study. Criteria for exclusion include reverse obliquity fractures, dementia, pathological fractures and prior hip fractures. Those patients treated with percutaneous external fixation under image intensifier from 2015 to 2020 in Ibn Sina Training Hospital in Baghdad. Results: At 1-year follow-up, 80% returned to pre-fracture ambulatory status. Average time to fixator removal was 12 weeks. There were no cases of pin loosening, breakage, or penetration of femoral head. All patients were evaluated clinically and radiologically for 24 months except 3 patients, 2 died 6 months’ post-operative due to causes unrelated to the surgery, and 1 lost follow up 3 months after surgery. Excellent and good results were found in 8 patients. The time of radiological union and fixator removal about 12 weeks. Pin tract infection occurred in most of the patients. Varus malalignment occurred in 20% of patients. Shortening ranged from 0 to 3 cm. Conclusion: External fixation of intertrochanteric fractures in elderly high-risk patients is a dependable, successful, and safe therapeutic option. Keywords: Intertrochanteric fracture, external fixator, elderly patient Citation: Alsudany FKI, Alhamashi AHS, Al-Abbody HHT, Ismael HA. Treatment intertrochanteric fracture of femur in elderly by external fixation: prospective case-series study; Ibn-Sina Training Hospital, Baghdad. Iraqi JMS. 2022; 20(1): 113-120. doi: 10.22578/IJMS.20.1.15
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Alsudany et al. (2022) conducted an observational in Intertrochanteric fracture of femur (n=28). Percutaneous external fixation was evaluated on Return to pre-fracture ambulatory status at 1-year follow-up. Percutaneous external fixation for intertrochanteric fractures in high-risk elderly patients resulted in 80% returning to pre-fracture ambulatory status at 1-year follow-up.
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